{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" MELISSA D ALEXANDER","gend":1,"add":"104 AVONLEA DR","city":"CHESAPEAKE","state":"VA","zip":"23322-9998","dob":"1970-06-14","age":"","mstatus":"","insh":"1202204*01","cliId":"","pno":"757\/701-4369","cno":"757\/701-4369, 757\/523-8669, ","email":"","ename":"","eno":"","pphy":"GERMSCHEID, MEGAN DO","ppno":"757\/606-1656","pcpadd":"3235 BRIDGE RD #15","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":"23435-9998","pcpcounty":"","pcpid":110777,"pcpname":"Family Physicians of Chesapeake","plan":"OHP - OPTIMA","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R13.12","K59.00","K58.9","R13.10","Z86.010","K21.9","E11.9","I10.","E78.49","F41.9","K59.04","Z12.11"],"date":["2020-11-09","2020-10-27","2020-10-27","2020-10-27","2020-10-27","2020-10-27","2021-06-16","2021-06-16","2021-06-16","2020-03-02","2020-11-09","2020-11-09"],"priorHcc":["","","","","","","","","","","",""]}},{"a":[]}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","57599000101","FREESTYLE KIT SENSOR","SENSOR","2","Select","Select",""],["","00228202996","ALPRAZOLAM","0.5MG","15","Select","Select",""],["","65862055990","PANTOPRAZOLE","20MG","-90","Select","Select",""],["","55111032201","GLIMEPIRIDE","4MG","180","Select","Select",""],["","70377000315","SIMVASTATIN","20MG","90","Select","Select",""],["","00002143480","TRULICITY","1.5\/0.5","2","Select","Select",""],["","68180031909","BUPROPN","150MG XL","30","Select","Select",""],["","00006008061","JANUMET","50-1000","10","Select","Select",""],["","00597015330","JARDIANCE","25MG","90","Select","Select",""],["","68180098003","LISINOPRIL","10MG","90","Select","Select",""],["","00456120130","LINZESS","145MCG","30","Select","Select",""],["","43386009019","GAVILYTE-G","","4000","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","00378427677","VALACYCLOVIR","1GM","30","Select","Select",""],["","67877021560","CEFUROXIME","250MG","20","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":""}]}]}